M.E.Müller: Atlas: Fracture 42-C1

Tibia/Fibula, Diaphysis,
complex fracture, spiral
0,29% of the total
1,50% of the tibia
2,69% of the segment

102 fractures
64,5% group
61%M, 39%F

39 fractures
24,7% group
56%M, 44%F

17 fractures
10,8% group
47%M, 53%F

With two intermediate fragments +Q With three intermediate fragments +Q With more than three intermediate fragments +Q

These are complex, multifragmentary fractures of the tibial diaphysis that, once reduced, have no contact between the proximal and distal fragments. The fracture line is grossly spiral, with three intermediate fragments. Ref. Manual of Internal Fixation:
26 - 27. 200 - 207. 232 - 251.
374 - 392. 572 - 587.
Surgeon. RO.

These fractures are characterized by very difficult reduction and treatment, especially when located close to the metaphyseal areas. In the illustrated case, the center of the fracture is in the diaphysis (this is why it is classified as a 42) but the fracture extends to the tibial pilon. The reduction must be meticulous and very gentle with the soft tissues. The internal fixation, minimal but sufficient, is performed with a titanium plate, previously contoured, to which the fragments are reduced, linked together and to the plate by lag screws.

A provisional external fixator gives additional stability to the internal fixation “ad minimum”. The availability of hybrid external fixators, with Ilizarov-like rings, allows epiphyseal fixation with tensioned Kirschner wires that do not interfere with other implants.

preoperative preoperative postoperative postoperative

+ 4 months + 4 months + 1 year + 1 year




						Tibia/Fibula, Diaphysis, complex fracture, spiral	0,29% of the total 1,50% of the tibia 2,69% of the segment






These are complex, multifragmentary fractures of the tibial diaphysis that, once reduced, have no contact between the proximal and distal fragments. The fracture line is grossly spiral, with three intermediate fragments.		Ref. Manual of Internal Fixation: 26 - 27. 200 - 207. 232 - 251. 374 - 392. 572 - 587. Surgeon. RO.

These fractures are characterized by very difficult reduction and treatment, especially when located close to the metaphyseal areas. In the illustrated case, the center of the fracture is in the diaphysis (this is why it is classified as a 42) but the fracture extends to the tibial pilon. The reduction must be meticulous and very gentle with the soft tissues. The internal fixation, minimal but sufficient, is performed with a titanium plate, previously contoured, to which the fragments are reduced, linked together and to the plate by lag screws.	A provisional external fixator gives additional stability to the internal fixation “ad minimum”. The availability of hybrid external fixators, with Ilizarov-like rings, allows epiphyseal fixation with tensioned Kirschner wires that do not interfere with other implants.